Tough point in my life

[BearFeet]

Hi guys, thanks for reading. I'm a semi new grad nurse who was lucky enough to land his dream job in a level 3 trauma ED pretty much right out of school. I've been there for 4 mos and am astounded by how much I've grown as a person and as a nurse. It was always my intention to work in the ER ever since I started nursing school, and once clinicals came around I knew I definitely did not want to do tele/med surg, LTC, etc. No offense meant at all, just not for me. Anyway, I pretty much had no issue with school. I hated it but who doesn't hate school?

During clinicals I always requested to be sent to the ER if possible and I even did my preceptorship in an ER. The problem comes right around the 1 year mark in the program when things started to change. I changed. I had always been up for a challenge, and never really afraid to step out of my comfort zone until then. It started out slowly, maybe not feeling like speaking up in class, and evolved months later into full blown panic attacks, depression, auditory hallucinations, and even suicidal ideation.

Even though I felt so miserable, I tried to hide my feelings and seek help without any one of my family or friends knowing. I didn't want ppl to think I was crazy. I was started on medications as prescribed by my dr and I thought "this is great! I'll be my old self again", but it never happened. Since then I've tried 3 different anti depressants/psychotics along with benzos all in vain, with the exception of the auditory hallucinations which finally cleared up. My grades dropped significantly but I managed to pass the program and my nclex. I was done with school but now I noticed I never wanted to leave the house anymore. It was like the whole world was out to get me.

I didn't want to be a nurse or even work for that matter. To hell with that, I wanted to feel safe in my bed, even if it meant being broke and secluding myself from the world. My family at this point knew something was definitely wrong. after all, my behavior went from 100-0 real quick, in the span of a little over a year. They tried their best to get me to start looking for a job. I finally agreed to attend a job fair just for the sake of having them get off my back. I didn't think I would walk away from there with a job. And of all places, in the ER! I was petrified. But opportunities don't come around like this often, this is what the past me would've killed for, so I reluctantly accepted the position.

Boy was that a mistake. I am now on a website asking for advice on what I should do with my life as a last resort. I love my job, and absolutely despise it at the same time. Job stress has made my problem so much worse. I don't even enjoy my days off cuz all i can think about is having to go back in. I'll stay up for hours crying, and then get frustrated and punch a wall, or even practice IVs on myself just to get my mind off the anxiety. I've called in 3 times just because I know there was no way I was going to be able to function. When I have a panic attack at work, it is insanely difficult to function or even calm myself down from it. And in a unit where ppl can go south fast, that presents a huge problem. I want to quit everyday but I also fear the repercussions of what that might do to me down the line.

So nurses of the world, help a lost brother out. Should I quit, get myself back together, and return to the field? Should I leave the field and find some other unrelated mundane job until I am better? Should I stick it out even though I'm a mess? Please guys, This has been an immense issue for me, and any advice is appreciated. Thank you and sorry for the novel.

[calivianya, BSN, RN]

Everyone's right - you need to get help now - I won't expound on that - and you need to resign from your job right away.

This is about your future - three absences likely already has you on management's radar. At four in a rolling year period, my facility puts people on disciplinary action. At three call outs in four months, as a new employee, you are really in the danger zone. When you get asked down the road if you've ever been terminated from a job, you don't want to say, "Yes, I was experiencing real difficulties with my mental health and called out frequently" or even just "Yes, it was from excessive absenteeism." That is REALLY going to hurt your ability to find a job later.

Quit while your resume is still salvageable, and get help. Like above people said, you can always say "It just wasn't a good fit" or something later, as long as you haven't gotten terminated.

[Idaho_nurse]

I dont have much to add except be nice to yourself and you are recognizing what your going through, so that is the first start. I would think back to when the triggers first started. I know you said that you landed in ED right out of school, and that kinda triggered me to wonder if you were not quite ready for the stress that the ED brings. Are you not fully comfortable with the level of care or level at which you are expected to perform? is it personal that is triggering it? I think some soul searching would be a good thing. if its the stress of the ED that is triggering this, maybe a department change for now would be a good thing. the OR, while still stressful, is not nearly as much as the ED and can be very fulfilling. or even another dept for awhile. there is nothing that says you cannot go back to the ED when you feel more yourself.

The thing that jumped out at me is the "suicidal idealization". That scares me, and something is really going wrong to get you to that point. my take is that its the stress of the ED.. cause face it, in the ED, we see death, people at their worst, trauma, etc... you could be going through PTSD from your experiences there. Just something to think about anyways.

Anyways, no matter what, find out what it is, and I will support you in that. its very personal, so only you can find out the cause and make the strides to fix the situation. Good luck and I have my fingers crossed for you.

[Been there,done that, ASN, RN]

Wow i didnt expect so many comments. Big thanks to all for your kind words and sound advice.

Unfortunately, a. leave of absence isnt an option. But i completely agree that my health is more important than a job. Ill pick up where i left off later. Ill be seeking out a psychiatrist as well. As far as working goes, ill be meeting with my director soon to discuss if part time or prn would be an option for me. If not, i guess im walking. Im not sure what ill do if i walk, but i guess ill figure it out. Im also not sure if i should tell her exactly why i want to decrease my workload.

Again thanks for all your responses and kind words. It means alot to me. Hugs all around

Do not tell your director ANYTHING regarding your health. It is private, between you and your doctor. It is NOT necessary to disclose and can and will be used against you if you do.

[Oceanpacific]

Idaho Nurse, Actually, I don't think now is the time for the OP to do soul searching or to try to identify triggers. He likely needs to stop analyzing things and start getting high quality care. Something to help with sleep and to decrease the panic would be a godsend.

[quiltynurse56, LPN, LVN]

The fact that you recognize that something needs to change and change soon tells me that you recognize you are in crisis mode. If your facility won't allow a medical leave, then you may need to quit. As has been said, you can say it wasn't a good fit for you or even that you were experiencing health issues where you were not able to work temporarily. Get that help soon. There are so many meds out there that if something doesn't work, another will or a combination will. Don't give up on meds. Talk therapy will also help you identify areas of your life/thinking process that you are going to need to work on. I advocate therapy that includes both meds and talk therapy. Let us know how things go for you.

[odaat]

I second the above to NOT tell your employer why you are leaving, it can and WILL be used against you. The BON views mental instability in the same light as substance abuse as far as patient safety is concerned. I don't say this to scare you or tell you to not get help because you definitely need to do that, just telling you to keep things very private!! I would hate to see you get broadsided by the BON on top of everything else you're dealing with.

Having said that, theres a reason the BON is concerned for patient safety. You can't adequately take care of patients in your situation and trying to is just going to make things worse for you. Take the leave of absence or just quit ASAP and take care of yourself. Your career will still be there when you are well again.

[Anna Flaxis, BSN, RN]

I would recommend going to another emergency room and checking yourself in to a psych hospital/unit for short term treatment. This is especially true if you are suicidal. You can get stabilized and get medication management in a safe place.

Perhaps this varies by region, but in my experience, unless you present an imminent risk to yourself (i.e. have active suicidal ideation, a plan, and the means), you are not likely to be considered admissible and it is unlikely you will get an inpatient placement. This is because behavioral health resources are so scarce that only the most severe cases can be admitted- and even then, it's not uncommon to linger in the emergency room for days. This is particularly true with minors, as pediatric/adolescent behavioral health services are even more scarce than those for adults.

Also it's important to note that not every emergency department is equal in this regard. EDs that have an attached behavioral health inpatient unit are a better bet, because these behavioral health units are allowed by law to prioritize admitting patients from their own ED.

That is not to say you should not go to the emergency room. If you are having active thoughts of self harm, you have a well thought out plan, and the means to carry it out, go. Now. Do not pass "Go". Do not collect $200. Another benefit, if you are not actively suicidal, would be that if you present for anxiety/depression and you answer the questions honestly, as you have described your symptoms here, you will receive a mental health evaluation and a referral to a behavioral health provider to follow up with as an outpatient, which would get your foot in the door with some behavioral health services.

How this all will affect your employment status and your nursing license are secondary concerns to your well being. Best of luck, and I hope to hear from you, updating us on how things are going for you.

[No Stars In My Eyes]

Don't know if this would work for you or not; is there another, different hospital ER you could go to? Because what I did when I got to bottoming out in my life, was, I called my Dr's office and said I needed to talk to the Doc himself because I could not stop crying and I was feeling really desperate. (All told, that day I must've cried for 5 hours or more, pretty much continuously.)

He called back within 3 minutes. I told him I didn't want to make an appointment for a few days from then, I needed to see somebody right NOW, and I could be anywhere in the city within 20 minutes .

I guess I was crying about everything I had kept pent up for a long time. The trigger was a very small occurrence that 'merely' opened the flood gates for EVERYTHING since from the beginning of my life, 45 years prior!

Well the Doc told me to go to the X-Hospital ER, a Psych Social Worker there would be waiting for me so I could be seen immediately.

The upshot was that I got admitted to an outpatient Mon.-Fri. program for two and a half weeks (I squeezed the extra 1/2 week out of the insurance; I really didn't, at that point, want to leave the program!) It was 10 AM to 4 PM and we had 'classes' and group discussions with 6 different psychologists over the course of each day. Also included art therapy and group-walking outdoors for 30 min after lunch. You had to participate in everything.

I worked a Home Health Baylor Weekend, so it was possible to work AND do the program. My Doc wrote an order for me to be on light-duty which meant I could work in the office each weekend, doing little picky-pookey, quiet, busy-work things like filing, organizing, taking inventory. Don't know how I would've got by if I lost my paycheck for that period of time!

Before anyone left the program they had to have set up a series of appointments with a psych professional, to carry on with individual therapy. I submitted one appt per week to insurance and covered the second appt out of pocket. It reeeaaalllllly helped me a lot to have one non-judgmental person to whom I could talk and who would point me inward and help me discover my "stuff" in my own way, in a safe place.

So, I didn't get answers, but I found different methods to help myself find answers. And the funny thing is that to this day I can still go inward to consult with my therapist; I joked with her that I can still hear the "Little Henrietta" (not her name) in my head asking me questions and suggesting different considerations for me to investigate. And it doesn't cost $175 per 50 minute hour! She said that she must have done her job well. She did.

It's a thousand wonders to me that I didn't just burst out of my own skin that day I called the doc. But I was soooo very practiced at clamping down, that I didn't feel it anymore. So my body took over for me and by god, then I felt it!

The whole experience was pretty rigorous but I had taken the stand that if I had to go through all this, and apparently I did have to, I was going to unzip my brain and heart and turn them inside out, or in another similar metaphor, turn over every rock sixteen times, if that's what it took.

I sure hope you can find a way to get the support you need. I feel ya, I really do.

[VivaLasViejas, ASN, RN]

I feel for you too.

I had to leave nursing and go on Social Security disability because my depression and anxiety became so severe I could no longer work. I suffer from bipolar 1 disorder as well, and unfortunately I waited to get help until my illness had begun to destroy my career. Don't be like me---find a mental health professional and get out of that job situation STAT. Given your panic attacks and your suicidal ideation, you may be unsafe to take care of patients at this point in time; once you get stabilized you can always find another job.

A side note: NEVER disclose your health problems to an employer if you can possibly help it. I did, twice, and lived to regret it. They may not be able to let you go based on your illness, but they'll find other ways to get rid of you. Rarely does disclosure work to the advantage of the employee, and even when it does, there's an undercurrent of suspicion---as if they expect you to implode if you get too stressed.

Wishing you the very best whatever you decide to do. Just know that you are NOT alone, there are a lot of nurses in similar circumstances and it's not their fault, nor is it yours. (((HUGS))) to you.

[dmarsan14]

I like your post, and myself recommend the same.

[dmarsan14]

Hello there:

I have been there too and I understand what are you going through right now. The good news are that you aren't alone and that this has a treatment. Bad news is that you need to be patient because the treatment isn't magic, it requires weeks in your blood in order to work.

First I agree that you need to seek the help of a psychiatrist. For me, I needed to take several medications until I found the right one that worked for me. This is the problem with antidepressants: what works for me it might no work for you. With your doctor, you can work to find the right med or the right combo of meds that will work for you.

DO NOT QUIT YOUR JOB!!! as hard as is for you, is the only thing that is keeping you for insanity. You can ask to change to a less stressful floor or change to a part time job while you get yourself back on track. Your job offers a way to keep your mind out of the anxiety/depression, plus it will give you some cash to afford doctor and meds.

Look for some therapist in your area that works with cognitive-behavioral therapy. Along with the meds it will help you and your family to get through this difficult moment. It worked for me and research shows that is really effective.

Connect with your spiritual self through praying, yoga, meditation. It was hard for me to do yoga during my great moments of depression, the only I could do was praying. Later when you start to feel better, you can start yoga or meditation. Even going for a walk for 30 mins a day is really beneficial. I know it is really hard to push yourself out of the bed, but repeat to yourself that YES you can do it, you can get through this.

I also did some postcards with positive messages that I read in moments of panic attacks or desperation. Things like: I have been through panic attacks before, and I know this sensations are going to pass. Make several of this card and carry them with you. I still keep mine in my wallet just in case. They are with me wherever I go.

Please tell your family or real close friend(s) what is going on with you. You may need for someone to stay with you during your critical moments. You might need a hand to hold or a shoulder to cry on. Also they can help you to get you out of bed and oblige you to "perform". I know it is hard but it is the only thing is going to help you. You need to get your mind distracted and focus on other things rather that focus on your feelings or sensations.

Try to find the right help, and I know you will get through this. It is hard, it is ugly but YOU CAN DO IT!!!

[hppygr8ful, ASN, RN, EMT-I]

Wow i didnt expect so many comments. Big thanks to all for your kind words and sound advice.

Unfortunately, a. leave of absence isnt an option. But i completely agree that my health is more important than a job. Ill pick up where i left off later. Ill be seeking out a psychiatrist as well. As far as working goes, ill be meeting with my director soon to discuss if part time or prn would be an option for me. If not, i guess im walking. Im not sure what ill do if i walk, but i guess ill figure it out. Im also not sure if i should tell her exactly why i want to decrease my workload.

Again thanks for all your responses and kind words. It means alot to me. Hugs all around

In my humble opinion and I've been an acute psychiatric RN for many years, you are currently unable to work safely at your present job. Still you should go to your employer . tell them you are experiencing a health crises and ask from a Leave of absence, even if it's unpaid. Then go to HR and get information about EAP Employee Assistance Program. This will avail you of low or possibly even free mental health consultation and referrals for a psychiatrist to do medication management and a psychologist to do talk therapy. The two work hand in hand. There are many nurses who struggle with mental health issues including myself. (I tried to kill myself in 2004). This is not a journey you need to take alone. If you were in my area I could give you some great referrals. You need a good differential diagnosis to find out what exactly is going on then the proper counseling and medication to get healthy and functional. If you can't afford treatment just walk into any ER (preferably not the one you work) and tell them you are thinking about harming yourself. That will get you in-patient real fast. You get a good assessment over 72 hours and possibly a bit longer stay and you will leave with a handful of referrals and in most cases a 30 day supply of meds. Also take your medication exactly as prescribed - don't stop because your either feel you are better or if you feel it's not working. We are here for you but we are just a bunch of faceless stranger with no dog in this fight.

Practice good self care first - you can't help anyone if you are sick.

Peace and Namaste

Hppy